Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 https://doi.org/10.1186/s13002-018-0217-8 RESEARCH Open Access Traditional knowledge on herbal drinks among indigenous communities in Azad Jammu and Kashmir, Pakistan Neelam Rashid1,3, Rodrigue Castro Gbedomon2*, Mushtaq Ahmad3, Valère Kolawolé Salako2, Muhammad Zafar3 and Khafsa Malik3 Abstract Background: Traditional knowledge about the use of medicinal plants for herbal drinks (HDs) is not well documented in the Azad Kashmir region despite their widespread use. This study highlights the taxonomic diversity and traditional knowledge on medicinal plants used for HDs while examining the diversity of diseases treated with HDs in the study area. Methods: Individual discussions were conducted with 255 informants (84 women and 171 men). Data gathered included (i) informant age and gender, (ii) HD species and respective plant parts used, (iii) health disorders treated, and (iv) mode of preparation and utilizations. Quantitative ethnobotanical indices including relative frequency of citation (RFC), informant consensus factor (ICF), and use value (UV) were used for data analyses. Results: Altogether, 73 medicinal plants belonging to 40 families and 66 genera were reported to be used in HD preparations, with Asteraceae being the richest family. The average number of HD species cited was 9.09 ± 0.17 per informant and did not vary either by age or gender. In addition, men and women, and adults and the young used the same pool of species (dissimilarity nearly zero). The most used plant parts were leaves (20.00%), roots (17.25%), and fruits (16.47%). Based on UV, the top five most used species were Valeriana jatamansi, Isodon rugosus, Onopordum acanthium, Acacia nilotica, and Viola canescens; and the UV was similar among gender and age categories too. The most utilized herbal preparation forms included decoctions, infusions, and tea. One hundred and eleven diseases grouped into 13 ailment categories were reported to be cured using HDs. The main category of disease treated with HDs was gastrointestinal (GIT) disorders (RFC = 17.43%). Relatively few species were used by a large proportion of informants for each category of ailment (ICF ≥ 0.60). Only one species was used for “glandular disorders” and “eye diseases” (ICF = 1). A novelty of about 22% (16 species) was recorded for HD species in the present work. Conclusion: The diversity of medicinal plant species used as HDs and the associated traditional knowledge are of considerable value to the indigenous communities of the Azad Kashmir region. Therefore, there is a need for conservation and preservation of medicinal HD species as well as the wealth of indigenous knowledge. The conservation effort should be high for species in the ailments categories glandular disorders and eye diseases. The therapeutic uses of HDs have provided basic data for further research focused on phytochemical and pharmacological studies and conservation of the most important species. * Correspondence: [email protected] 2Laboratoire de Biomathématiques et d’Estimations Forestières, Faculty of Agronomic Sciences, University of Abomey-Calavi, 04BP 1525 Cotonou, Benin Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 2 of 20 Background the conservation issue, the excessive use of medicinal Traditional medicine (TM), also known as complemen- plants may lead to the misidentification of adulterant tary and alternative medicine in developed countries, is plants, hence compromising the quality control and widely used and is of rapidly growing interest in health standardization [25]. Moreover, ethnobotanical medi- care systems all over the world. About 80% of the cine in Pakistan is still a huge field of investigation. The world’s population, particularly in developing regions, last review on medicinal plants in Pakistan [25]evi- relies on TM practices to meet their health care needs denced the gaps of knowledge on herbal medicine and [1, 2]. TM is very popular and attracts much attention called upon extensive research. This paper aims at con- from a large spectrum of health system stakeholders, not tributing to this ongoing body of knowledge in herbal only for its accessibility and affordability for poor people medicinal, focusing on HDs. but also because of the risk of adverse effects of chem- HDs refer to beverages made from the infusion or de- ical drugs in allopathic medicine. As a recognition of its coction of herbals, spices, fruits, or other plant mate- importance and as a response to skepticism and disbelief rials, served cold or hot. They include herbal teas, fruit from some stakeholders, in 2002, the World Health drinks,infusions,anddecoctions.HDsarehighlyap- Organization defined a strategy to address issues of pol- preciated mostly because of their therapeutic purposes icy, safety, efficacy, quality, access, and rational use of [26]. In Pakistan, the available literature on medicinal TM [3]. TM includes medication therapies and non- plants used for HDs is recent and preliminary [2, 27], medication therapies. Whereas the latter are carried out and important issues remain unanswered and insuffi- primarily without the use of medication, the first involve ciently documented. Using the region of Azad Jammu the use of herbal medicines [4–6], animal parts [7–10], and Kashmir in Pakistan, this study aims at: and minerals [11, 12]. Among the medication therapies, herbal medicine or 1. Assessing the taxonomic diversity of plants used for phytotherapy is encountered worldwide, and its use is HDs. The medicinal plant richness of Pakistan is very ancient. Human use of plants as medicines was estimated to be about 600 to 700 plant species [25]. dated to at least the Middle Paleolithic age some What is the taxonomic composition of the pool 60,000 years ago [13, 14]. The Himalayan region com- selected for HD preparation? Based on the non- prised of Afghanistan, Bangladesh, Bhutan, China, random selection theory [28, 29], which predicts Myanmar, Nepal, Pakistan, and India is reputed to be a that medicinal plant selection is not random, it is rich storehouse and hotspot of valuable medicine plant expected that the number of medicinal plant species. About 1748 plant species corresponding to species used for HDs differs across botanical 21.85% of the local 8000 angiosperm species are used for families. medicinal purposes [15]. 2. Assessing the traditional knowledge on HDs and its In Pakistan, the flora is quite rich and is estimated to relationship with age and gender. Indeed, the use of consist of about 6000 species of higher plants of which medicinalplantsisbasedontrialanderrorandis 600 to 700 species, the majority growing in the wild, are passed on from one generation to another, after used for medicinal purposes [16]. Throughout the coun- refinement and additions [30]. What is the try, TM using plant species is popularly practiced among traditional knowledge (species uses, plant parts a large segment of its population [17–20]. Eighty percent used, mode of preparation, etc.) related to HD of people belonging to the rural areas still depend upon preparation? Because various individual socio- the herbal medicines in Pakistan. The most realistic and cultural and demographic traits, mainly gender and commonly employed therapy for diseases is to make in- age, are correlated with an individual’s level of plant fusions or decoctions from different plant parts [21]. knowledge [31–33], we expected traditional know- Local market systems named “Pansara” specifically dealing ledge related to HDs to be associated with age and with medicinal business have been reported [16, 22–24], gender. With women and older people tending to with important quantities of plants exchanged locally or have a greater knowledge of local medicinal flora exported. For some years, important concerns due to ex- [31, 34], we hypothesized that traditional know- cessive use of herbal medicine have arisen and are related ledge on HDs is mostly held by women and old to the conservation issue of medicinal plant species [16] people in Pakistan. and adulteration of botanical medicine [24]. Indeed, the 3. Assessing the diversity of diseases treated by HDs. majority of medicinal plants used for the herbal drug in- About 10–12% of plants in Pakistan are used to dustry and local communities come from wild collection. meet health care needs. In the special case of HDs Overexploitation and unsuitable collection methods are made of medicinal plants, what diseases are treated, contributing to the extinction of some medicinal plants and which plants are solicited? We expected some and bringing others to the brink of extinction [16]. Beyond diseases to be treated by a restricted set of plants. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 3 of 20 Methods Ethnographic and socio-economic characteristics of the Study area Azad Jammu and Kashmir region The region of Azad Kashmir is positioned between Overall in the Azad Jammu and Kashmir region, 34°22′ North latitude and 73°28′00 East longitude. Mughals, Syed, Raja, Chaudhary, and Maliks are the The total area is about 13,297 km2 [35]. The study prominent castes. Azad Kashmir is generally considered sites included eight districts; Muzaffarabad, Mirpur, as a Pahari speaking region. There is a large Gojri Kotli, Bagh, Poonch, Palandari, Neelum, and Bhimber. community and some pockets of Kashmiri, especially in The region of Azad Jammu and Kashmir is character- Neelam Valley regions.